From the Guidelines
Gabapentin is recommended as a first-line treatment for neuropathic pain, with a typical starting dose of 100-300 mg nightly, increasing to 900-3600 mg daily in divided doses 2 to 3 times a day, as supported by the most recent and highest quality study 1.
Key Points
- Gabapentin works by binding to calcium channels in the nervous system, reducing the release of excitatory neurotransmitters and thereby decreasing abnormal neuronal activity, as explained in 2 and 3.
- The medication takes effect within 1-2 hours but may require several weeks of consistent use to achieve maximum therapeutic benefit for conditions like neuropathic pain, as noted in 4 and 5.
- Common side effects include dizziness, drowsiness, and fatigue, which often improve with continued use, as reported in 2 and 6.
- Patients should take gabapentin with food to reduce stomach upset and avoid abrupt discontinuation as this can trigger withdrawal symptoms or seizures, as advised in 2 and 3.
- A gradual tapering schedule over at least one week is recommended when stopping the medication, as recommended in 2 and 3.
- Elderly patients and those with kidney impairment typically require lower doses, as noted in 4 and 5.
Dosage and Administration
- The typical starting dose is 100-300 mg nightly, increasing to 900-3600 mg daily in divided doses 2 to 3 times a day, as supported by 1 and 3.
- Dose increments of 50%-100% every few days, with slower titration for the elderly or medically frail, as recommended in 3.
- Dose adjustment required for those with renal insufficiency, as noted in 4 and 3.
From the FDA Drug Label
Gabapentin tablets are a prescription medicine used to treat: Pain from damaged nerves (postherpetic pain) that follows healing of shingles (a painful rash that comes after a herpes zoster infection) in adults Partial seizures when taken together with other medicines in adults and children 3 years of age and older with seizures.
The main uses of Gabapentin are to treat:
- Postherpetic pain in adults
- Partial seizures in adults and children 3 years and older with epilepsy, when taken with other medicines 7
- Postherpetic neuralgia in adults
- Partial onset seizures in adults and pediatric patients 3 years and older with epilepsy 8
From the Research
Gabapentin Overview
- Gabapentin is commonly used to treat neuropathic pain (pain due to nerve damage) 9
- It is effective in providing substantial pain relief (at least 50% pain relief over baseline) in patients with postherpetic neuralgia and painful diabetic neuropathy 9
Efficacy of Gabapentin
- Gabapentin at doses of 1200 mg or more daily can provide good levels of pain relief to some people with postherpetic neuralgia and peripheral diabetic neuropathy 9
- Around 3 or 4 out of 10 participants achieved at least 50% pain relief with gabapentin, compared with 1 or 2 out of 10 for placebo 9
- Gabapentin demonstrates similar effectiveness in alleviating neuropathic pain as pregabalin and amitriptyline, but with fewer adverse effects 10
Combination Therapy with Gabapentin
- Gabapentin and pregabalin can be used in combination to reduce the dose of an individual agent, its side effects, and to enhance therapeutic response compared to a single agent 11
- Combination therapy with gabapentin and other medications, such as morphine, pregabalin, and duloxetine, can produce a synergistic effect on mechanical allodynia, but not on neuroma pain 12
Adverse Effects of Gabapentin
- Adverse event withdrawals were more common with gabapentin (11%) than with placebo (8.2%) 9
- Serious adverse events were no more common with gabapentin (3.2%) than with placebo (2.8%) 9
- Common adverse events associated with gabapentin include dizziness, somnolence, peripheral oedema, and gait disturbance 9